Download race and medicalization of drug addiction

RACE AND MEDICALIZATION OF DRUG ADDICTION:
AN ANALYSIS OF DOCUMENTARY FILMS
by
Brittany Lynn Scott
A thesis submitted to the Faculty of the University of Delaware in partial fulfillment of
the requirements for the degree of Bachelor of the Arts in Sociology with Distinction.
Spring 2010
Copyright 2010 Brittany Lynn Scott
All Rights Reserved
RACE AND MEDICALIZATION OF DRUG ADDICTION:
AN ANALYSIS OF DOCUMENTARY FILMS
by
Brittany Lynn Scott
Approved: __________________________________________________________
Tammy Anderson, Ph.D.
Professor in charge of thesis on behalf of the Advisory Committee
Approved: __________________________________________________________
Joel Best, Ph.D.
Committee member from the Department of Sociology and Criminal Justice
Approved: __________________________________________________________
Barbara Settles, Ph.D.
Committee member from the Board of Senior Thesis Readers
Approved: __________________________________________________________
Ismat Shah, Ph.D.
Chair of the University Committee on Student and Faculty Honors
ACKNOWLEDGMENTS
This incredibly rewarding journey would not have been possible without
the continued support and guidance of the following people. I want to sincerely thank
my thesis advisor and mentor, Dr. Tammy Anderson for introducing me to an area of
social science research that has sparked my interest so greatly. Her constant support,
great wisdom, and friendship will continue to shape my career as a researcher
throughout my graduate and post-graduate life. I would also like to thank my second
reader, Dr. Joel Best, for his strong encouragement and continued concern for my
success as a researcher. The advice of Dr. Best and Dr. Anderson, along with many
other faculty members of the Sociology and Criminal Justice Department, has been an
invaluable part of my undergraduate life at the University of Delaware. I would also
like to thank my third reader, Dr. Barbara Settles, for her advice and guidance in
completing my thesis. Thank you to Meg Meiman and Sarah Paylor for their help
throughout this long process and in formatting my work correctly. A very special
thank you to my family and friends for their support and encouragement throughout
this journey!
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TABLE OF CONTENTS
LIST OF TABLES ......................................................................................................... vi
ABSTRACT..................................................................................................................vii
Chapter
1
INTRODUCTION AND LITERATURE REVIEW .......................................... 1
Literature Review ............................................................................................... 2
The Criminalization of Drug Addiction in the 20th Century ..................... 3
The Medicalization Model: From Criminal to Patient .............................. 7
Inequality and the Medicalization of Drug Addiction ............................... 9
2
METHODS ....................................................................................................... 12
3
FINDINGS ........................................................................................................ 18
Demographics ................................................................................................... 18
Drug Addiction Narratives................................................................................ 21
Exclusion of Minorities .................................................................................... 23
“Rehab” - Ally and Marvin...................................................................... 23
“American Justice: The Junkie Next Door” - Allison ............................. 24
Medicalization of Drug Addiction .................................................................... 24
“Meth: A County in Crisis - Cody” ......................................................... 24
“Dope Sick Love” - Michelle .................................................................. 25
“Constant Craving: The Science of Addiction” - Melanie ...................... 25
“Birthday: Methadone and Pregnancy - Denise”..................................... 26
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“Risky Business: Teens and Addictive Behavior – The Science of
Addiction”.................................................................................... 26
“Constant Craving: The Science of Addiction”....................................... 26
4
CONCLUSIONS/DISCUSSION ...................................................................... 28
Conclusion ........................................................................................................ 28
Discussion ......................................................................................................... 29
REFERENCES ............................................................................................................. 31
v
LIST OF TABLES
Table 1. Documentary Inclusion Criteria ..................................................................... 13
Table 2. Content Analysis Template: Demographic Data ............................................ 15
Table 3. Content Analysis Template: Addiction Narrative .......................................... 15
Table 4. Subjects’ Racial Breakdown ........................................................................... 18
Table 5. Subjects’ Racial Breakdown by Percentage ................................................... 19
Table 6. Claimsmakers’ Racial Breakdown ................................................................. 19
Table 7. Claimsmakers’ Racial Breakdown by Percentage .......................................... 20
Table 8. Drug Addiction Narratives ............................................................................. 21
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ABSTRACT
The purpose of our research is to investigate the relationship between
medicalization and explanations of drug addiction by race. Medicalization refers to
the process through which everyday behavior and traits are classified and/or treated as
medical conditions (Conrad 2005). If medicalized, addiction could be treated through
medical therapies rather than the criminal justice system. Advancements since the
1980s claim addiction is related to an individual’s biological and psychological
characteristics (Leshner 1997). Our research will explore the extent to which
minorities are excluded from these medicalized narratives of drug addiction and are,
alternatively, discussed using criminalized ones. We content analyzed 25
documentary films (mean length of 60 minutes each) spanning nearly15 years to shed
light on medicalization and race in drug addiction. Our research found definite
patterns in drug addiction narratives by race: whites were more often discussed via
medicalized narratives and minorities were under-represented, leading to a gap in
addiction narratives for them. Results suggest a persistent racial inequality in drug
abuse and addiction research and pinpoints possible negative consequences for
minorities.
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Chapter 1
INTRODUCTION AND LITERATURE REVIEW
Drug addiction is a debilitating condition that dramatically impacts the lives
of drug abusers, their families, and society as a whole. Research on the causes, effects,
and basic elements of drug abuse has been ongoing for at least a century; this research
has produced a variety of definitions and tactics for dealing with addiction. Within the
past decade, approximately, drug addiction researchers such as scientists, medical
doctors, and neurologists have maintained that drug addiction is a brain disease or the
outcome of some other biological process. Specifically, claimsmakers hold that the
continued use of drugs can manipulate and change the chemicals within the brain and
make a user become dependant upon the use of a substance, essentially causing addiction.
This medicalized narrative of addiction is a remarkable shift given that most of the 20th
century featured punitive and criminalized narratives and polices regarding addicts,
especially those addicted to illegal drugs.
I recently participated in a research group to study this medicalized view of
addiction and the research that surrounds it. Our group discovered a pattern of exclusion
of minorities within drug addiction research, which encouraged us to look at other types
of media to investigate the medicalization narrative and race. This most recent
medicalized view of addiction is also being explained in many documentaries and
television shows (such as “Intervention” and “Addiction”) as the cause of addiction as
well as the key to a possible full rehabilitation for addicts.
1
After viewing the HBO documentary “Addiction” and noting an inequality in
the races portrayed within the film, my advisor and I decided to look at documentaries as
another media of drug addiction research. The goal of this research is to analyze a
number of documentary films and observe the demographics of those subjects being
interviewed (drug addicts) and how their addiction is being examined or discussed within
the film. My research is therefore addressing two topics: drug addiction is becoming
increasingly medicalized, but it is not being medicalized for everyone. This research is
extremely important as it will determine how medicalization narratives are being shaped
by race, proving an inequality among different racial groups and how they are treated as
addicts; if you are not portrayed as a patient you cannot receive treatment.
Literature Review
Medicalization refers to the process through which health or behavioral
issues are classified and/or treated as medical conditions (Conrad 2005). This process
involves a move from a non-medical to a medical framework to discuss the problem;
therefore non-medical explanations for a problem (religious, moral, etc.) move toward
medical explanations and the use of medical terms (Shostak, Conrad and Horwitz 2008).
Medicalization then refers to a problem that: is defined in medical terms, can be
described using medical language, can be understood by adopting a medical framework,
and “treated” with a medical intervention. Medicalization, therefore, causes a shift in the
way we discuss certain issues and how they are perceived by the medical community and
the general public. For example, children that are hyperactive were once classified as
difficult and disobedient prior to the development and diagnosis of attention deficit
hyperactivity disorder (ADHD). In this respect, certain conditions which were once
defined as immoral or deviant can be defined, researched, and possibly treated through
medical means or medicinal treatment. With the creation of the American Psychiatric
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Society’s Diagnostic and Statistical Manual, a number of conditions that we previously
regarded as sins of morality or crimes against society were reclassified as medical
conditions or disorders (depression, homosexuality, etc.). This allowed for the
medicalization of deviant acts or behaviors such as addiction; deviance could then be
defined and possibly treated in a medical framework. (Shostak, Conrad and Horwitz
2008).
A medicalized narrative that can be applied to drug addiction has emerged
and grown rapidly within the past decade. Due to new technologies like brain or Positron
Emission Tomography (PET) scanning, addiction can be classified as a chronic disease
rather than a moral and legal crime against society. Prior to this shift, the 20th century
saw a focus on a criminalized view of drug addicts and an emphasis on extreme punitive
measures to “rehabilitate” them through the criminal justice system. This criminalization
narrative stigmatized all drug addicts, but research suggests the severity of punishment
was determined according to racial demographics.
The Criminalization of Drug Addiction in the 20th Century
In the late 19th and early 20th centuries, certain drugs (stigmatized in today’s
society) were viewed as medical treatments; for example heroin was first prescribed as a
way to cure people of morphine addiction as well as a stimulant while cocaine was used
as a natural stimulant in soft drinks and a medical treatment for various ailments (Brecher
1972; Spillane 2000). Prior to the use of heroin and cocaine, ancient civilizations utilized
the sources of each drug for a variety of purposes; opium (source of heroine) was used to
alleviate chronic illnesses and treat infections, while cocoa leaves (source of cocaine)
helped to fight fatigue and hunger (Courtwright 2001; Davis 1996). In the early 20th
century, with the passage of the Harrison Narcotics Act of 1914 (and the Supreme Court
cases that followed), these drugs were deemed deviant and criminal by the legal system
3
as well as society. Those who used these drugs were then considered to be criminals
following the passage of the act; these acts marked a shift from a medical view of these
drugs to a criminalized view of their use.
Researchers have noted that the origins of the Harrison Act were rooted in
racist motives and dislike for certain minority groups as well as for political gain.
According to Courtwright (2001) the opposition to certain drugs is generally connected to
a dislike of a particular group and usually motivated by the hatred of a certain race.
Beginning around 1913, the American government was approached by the Chinese to
help them curb the opiate addiction which ran rampant in their country. In exchange for
help, the US would be offered trade and economic success from the Chinese government.
Hamilton Wright therefore began a coalition to end the use of opiates (heroin) in the US
as to influence the end opium addiction on an international level. His tactics to pass the
Harrison act were to focus on the dislike of certain minority groups (African Americans,
Chinese, etc.) and use this to influence the state in their legal tactics (Musto 1999;
Courtwright 2001).
Their first campaign preyed on Chinese immigrant populations; their cultural
connection to opium use was associated with deviant sexual acts such as the raping of
young white women. Moral entrepreneurs would hypothesize that the Chinese immigrant
railroad workers would lure these women to their opium dens, and convince them to
partake in the drug. This would leave them vulnerable to deviant sexual acts (Musto
1999). The second campaign was geared towards the African American population and
their use of cocaine. Activists would claim that cocaine was used by African American
men to make them stronger, rebellious, and less vulnerable to modern weapons; the fear
was that cocaine would cause them to go on unstoppable violent crime sprees
(Courtwright 2001; Musto 1999; Cohen 2006). These successful campaigns led to the
4
passing of the Harrison Narcotics Act, which would define the stigma of drug addiction
for close to a century after its ratification.
While the 1960s and 1970s were run with a more liberal view on drug use,
with a focus on rehabilitation and issues of mental health, the 1980s ushered in a
conservative era and the War on Drugs. With pressure from various social groups, such
as The National Federation of Parents for a Drug Free Youth (NFP), the increase of urban
crime, and the growth of the international drug lord, the Reagan administration had a
strong focus on battling the spread of drug use and abuse, especially among teens
(McCoy 1991). During the first four years of the administration, Nancy Reagan’s “Just
Say No” campaign and Carlton Turner’s focus on international regulation of drug
production helped to decrease causal drug use among Americans (Massing 1998;
Chepesiuk 1999). However, problems of drug abuse and addiction still remained
(McCoy 1991).
The emergence of a crack cocaine epidemic in inner cities and the surge of
powder cocaine abuse in upper-middle class areas in the mid 1980s radically altered the
severity of the War on Drugs (Reinarman and Levine 1997). Crack cocaine, a cheaper,
more potent form of powder cocaine, became increasingly popular in the inner city in the
1980s. Crack cocaine was able to deliver the high of powder cocaine without the
expense; therefore, this drug was geared towards a lower-class market (Reuter and
MacCoun 1993). Crack cocaine was usually sold out on the streets (in the view of the
public) resulting in a severe, obvious, competition between dealers. Due to this public
market, and growing tensions between dealers due to issues of territory and clients,
violence and fatalities became a common characteristic of the crack cocaine epidemic
(Johnson, Golub and Fagan 1995). Drug related violence and homicides skyrocketed
during this time and dominated national news. As a direct result of the sensational
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epidemic, the Reagan administration modified drug legislation to include much harsher,
extended punishments for drug users and sellers (through The Comprehensive Crime
Control Act of 1984 and the Anti-Drug Abuse Act of 1986).
Disparities between the treatment of cocaine users and crack cocaine users
were significant following the passage of these acts. Upper-middle class users of powder
cocaine were usually able to avoid prison sentences by attending treatment facilities
(funded by their employers) while the lower class population using crack cocaine most
often ended up in prison. Also with the passage of the Omnibus Drug Abuse Act of
1988, the penalties for possessing equal quantities of each drug were drastically
differentiated. As a result, sentences for possession of crack cocaine are 100 times longer
than for the equivalent amount of powder cocaine (Mauer 2006). These inequalities of
class can also be regarded as a racial inequality, as a majority of the lower-class crack
cocaine users were minority populations. With the nomination of the George H.W. Bush
administration this harsh, punitive drug legislation persisted for the next four years, and
essentially influenced the next decade of drug enforcement. During his time in office,
Bush increased the budget for the War on Drugs to $7 billion dollars, as well as created
the position of the “Drug Czar” (Reuter and MacCoun 1993).
This history of drug legislation sheds light on the dominating notions of the
20th century regarding drug users and abusers. With the extensive promotion of the War
on Drugs, drug use became a moral dilemma of the public, and especially the youth of
America. A stigma was therefore attached to those who abused; users were looked on as
morally corrupt and deviant as opposed to unhealthy individuals who needed medical
attention. Also, when reviewing the earlier legal acts against certain substances and the
disparities between cocaine and crack possession laws, one can infer that these acts were
influenced by outside social issues such as political gain and ethnic and racial prejudices.
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Within the past decade, the new medicalized narrative being applied to drug addicts has
been following a similar path as it is being shaped according to racial and ethnic
characteristics.
The Medicalization Model: From Criminal to Patient
The medicalization model began developing in the late 19th century and has
progressed steadily using new biological and technological research. Numerous
approaches to medicalization have developed over time; among these are: the study of
body types and their connection to deviant behavior as well as genetic studies to examine
inherited traits of addiction such as alcoholism. Although these trends of medicalizing
drug addiction have been notable throughout the 19th and 20th centuries, their impact on
removing the stigma and modifying drug addiction treatments has been minimal up until
the past 15 years or so. According to Conrad, medicalization cannot be expected to
completely alter established methods of social control. Accordingly, subjects like drug
addiction are dealt with using “medical-legal hybrids,” due to their deep connection with
the criminal justice system (Conrad 1992). Therefore, from the roots of punitive drug
punishments in the early 20th century to the ultra conservative War on Drugs in the 1980s
and 1990s, drug addiction and addicts have been attached to the stigma of criminality.
However, within the past decade and a half, as science and technology
advance to the study of the brain, the medicalization of drug addiction has begun to alter
the view of a drug addict from a criminal to a patient. For example, the 1990s has been
recognized as the “Decade of the Brain,” in which neuroscience and brain-imaging
technology was implemented into the field of medical research. More specifically, the
appointment of neuroscientist, Dr. Alan Leshner, to the head of the National Institute on
Drug Abuse (NIDA) marked a dramatic shift in the way drug addiction would be
examined from that point on.
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According to NIDA’s online pamphlet, “Drugs, Brains, and Behavior – the
Science of Addiction”,
Addiction is defined as a chronic, relapsing brain disease that is
characterized by compulsive drug seeking and use, despite harmful
consequences. It is considered a brain disease because drugs change the
brain - they change its structure and how it works. These brain changes
can be long lasting, and can lead to the harmful behaviors seen in people
who abuse drugs (NIDA 2008).
According to drug addiction research, using brain imaging technology, drugs
stimulate the senses in the brain that produce pleasure. Pleasure is felt in the body as the
brain releases dopamine; in the use of alcohol and drugs an excess of dopamine is
released into the brain and the level is dramatically increased from its natural state. With
the continued use of these substances, the brain and body become used to the higher level
of dopamine present in the brain. The chemistry of the brain is then altered with the
sustained presence of the surplus and can no longer be satisfied with the natural releases
of dopamine. Therefore, the pleasure receptors in the brain are chemically modified and
with the absence of this higher level of dopamine the brain cannot function appropriately;
the brain then becomes dependant upon the drug to maintain a level of normalcy
(Fishbein 1991).
Consequently, an individual could start using a drug voluntarily, but through
a period of prolonged use the brain becomes dependant, causing the individual to
involuntarily seek out the drug to maintain stability. As a result, this addiction is
essentially a disease of the brain as these addictive substances are ultimately altering its
chemistry and causing dependence. Specifically, using brain scanning and comparative
images one can note the distinct, visible difference between the addicted and nonaddicted brain. The drug addict is then able to be viewed and examined as an individual
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with the disease of addiction, or a patient that is in need of medical treatment (Leshner
1997). However, upon reviewing this turn in the scientific research of addiction, one can
observe a distinct inequality between who is viewed as a patient and who is still
considered to be a criminal based on a pattern of exclusion.
Inequality and the Medicalization of Drug Addiction
This drug addiction research and its use of brain imaging can be extremely
beneficial in the treatment of drug addicts; upon being viewed as patients they can
receive the proper attention to their disease. However, the progression of de-stigmatizing
the addict and attempting to help them recover is dependent upon who is being
researched, how they are perceived by claimsmakers, and how they are portrayed to the
general public. Illegal drug use statistics show a disparity among some minorities
(specifically African Americans) in their level of drug use as compared to their
percentage of the population. According to the Substance Abuse and Mental Health
Services Administration in 2009:
Current illicit drug use among persons aged 12 or older varied by
race/ethnicity in 2008, with the lowest rate among Asians (3.6 percent)
(Figure 2.9). Rates were 14.7 percent for persons reporting two or more
races, 10.1 percent for blacks, 9.5 percent for American Indians or Alaska
Natives, 8.2 percent for whites, 7.3 percent of Native Hawaiians or Other
Pacific Islanders, and 6.2 percent for Hispanics (Substance Abuse and
Mental Health Services Administration 2009).
The Substance Abuse and Mental Health Services Administration also measured
substance abuse and dependence within the past year according to race and ethnicity in
their national study:
9
In 2008, among persons aged 12 or older, the rate of substance
dependence or abuse was the lowest among Asians (4.2 percent).
Racial/ethnic groups with similar rates included American Indians or
Alaska Natives (11.1 percent), persons reporting two or more races
(9.8 percent), whites (9.0 percent), blacks (8.8 percent), and Hispanics
(9.5 percent). These rates in 2008 were similar to the rates in 2002 through
2007(Substance Abuse and Mental Health Services Administration 2009).
These statistics demonstrate that the rates of dependence among whites, blacks, and
Hispanics are relatively close in percentage; therefore, if one wanted to gain an accurate
view of the drug addict population, all three races would have to be represented almost
equally.
According to Castro and Alarcón (2002), substance abuse treatment
programs have largely overlooked the cultural factors as determinants of drug abuse.
They note that many research studies have examined race, but in a “culturally shallow
manner;” many of them focus on a comparison of one specific racial group against the
behaviors of the white-majority to examine how they are different. These factors include
value/norms, beliefs, and behaviors that are largely associated with racial/ethnic
backgrounds; there is a need to study these cultural features as they can help improve and
shape the treatment of more individuals (Castro and Alarcón 2002). Subsequently, Dr.
Alan Leshner of NIDA has explained that there is a need to connect these issues of
culture to the current addiction studies and neurobiological explanations of addiction.
However, as Carlson et al. explains there are very few links between ethnographic and
neurological research and even less collaboration between neuroscientists and
ethnographic researchers. In order to have a more complete view of addiction to help destigmatize the addict and properly treat them, these two fields must be examined
collectively (Carlson et al. 2009). With the severe misrepresentation of minorities in
cultural/ethnographic research of drug use and abuse, there is a disparity between the
10
studies of whites and minority populations and their addiction narratives. This disparity
causes an inaccurate, biased view of addicts to be put forth in society, which in turn
influences who is targeted for medical treatment and care.
According to Schnoll, there is a significant need to connect the medicalized
narrative of drug addiction to mainstream society. With the recognition of addiction
medicine by the American Medical Association there have been great advances in the
progression of substance abuse treatment. However, issues of inadequate insurance for
addiction treatment and the view of addiction as an acute disease (rather than a chronic
disease) have leveled out the progression of appropriate drug addiction treatments.
Addiction medicine and the diagnosis of a brain disease must be promoted and shared
among researchers, clinicians, and the public in order to fully de-stigmatize drug
treatment (Schnoll 2009). One successful method for researchers and scientists to
influence the view of the public is the use of documentary films and commercialized
media sources.
Documentaries are a strong media resource and influential instruction tools
utilized by teachers, activists and politicians to connect to mainstream society; as the
research may be too complex in nature to understand, documentaries make it accessible
to the majority. Therefore, documentaries portraying the disease of addiction are
extremely important in the promotion of these neurological explanations. To view
addiction as a disease, the public will be more willing to endorse the treatment of addicts;
therefore, how certain groups are medicalized is the most important factor of influence
within these films. According to our research, these films have largely excluded minority
populations, causing an inaccurate portrayal of the addict as a patient.
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Chapter 2
METHODS
For our research we decided to perform a content analysis on a random
sample of documentary films which pertain to addiction and the disease of addiction. We
chose to use documentary films as the basis for our analysis because they are accessible
and vital to the promotion of drug addiction as a disease. As stated above, documentaries
are an excellent resource for members of the academic and scientific fields to
communicate complicated theories to the public in a straightforward manner.
Documentaries are essential to the promotion of drug addiction research and treatment for
several reasons. First, the focus of documentaries is on real people who have a real social
problem. They can educate the general public more personally by portraying real
addiction stories. Next, they have the potential to reach a wider audience than academic
literature. Documentaries are accessible to the public through classroom settings,
libraries, treatment programs, and syndicated television and cable shows “(Intervention”,
HBO documentaries, etc.) Finally, documentaries are extremely helpful in destigmatizing addicts as they put a visual face to the social problem at hand. These films
are humanizing the problem of addiction by portraying real stories that audiences can
relate to. By putting a human face to the statistics and myths of drug addiction, the
audience can connect to the addict and sympathize with their situation. Once they
understand the plight of everyday addicts, and visually witness their pain, the public is
more likely to change their opinion and support proper drug treatment. One can then
understand why it is so important to scrutinize who is being portrayed in these films;
12
when the stories are visually told, the white addict is shown more often than minorities.
If audiences are sympathizing with the white faces of addiction, what happens to the
minorities who are still being looked upon as criminal addicts? Therefore, we chose to
content analyze the specific cases or narratives depicted in documentary films.
For the analysis, we collected approximately fifty documentaries from a
variety of sources: Dr. Anderson’s private collection, Hulu.com, Google Videos, and the
University of Delaware Library. I developed a database of the documentaries and
recorded their: title, year produced, production company, distribution company,
producers, directors, and a brief description of the content. After reviewing the brief
content of each documentary, as well as viewing some that were questionable, we
developed a guideline or inclusion criteria to narrow down the sample. Our sample
needed to include documentary (nonfiction) films that would focus on specific cases and
first hand accounts of everyday illegal drug addicts. Therefore, we would only use those
documentaries that followed these criteria:
Table 1. Documentary Inclusion Criteria
The film must profile primarily drug addiction; alcoholism is excluded
It must profile people – drug addicts and specific cases
Those profiled have to have a problem themselves
Rule out celebrity biographies/accounts
The film must be a documentary – not a fictional account
These criteria stipulations allowed for us to narrow the films down to those
which would provide us with strong drug addiction cases of everyday users. The focus of
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our content analysis was on the abuse of illegal or illicit drugs, such as cocaine, heroin,
prescription drugs, etc. and their users. We chose not to look at alcoholism because
alcohol lacks a history of extensive criminalized substance abuse policies. Essentially,
alcohol consumption has not been viewed as a criminalized act for quite some time, and
therefore has not undergone a dramatic shift from a criminalized to a medicalized
narrative of addiction. Therefore, films that focused on alcohol abuse, and cases of
alcohol addiction in our documentaries, were left out of the final content analysis.
In
order for our sample to properly analyze the demographics of each film, they had to
portray individuals and their addiction stories; each film, therefore, had to focus on the
addicts and their individual addiction narratives, not just a basic overview of addiction.
We also wanted to represent the demographics of normal, everyday users that were being
depicted in documentary films. We then had to exclude documentaries about celebrities
and their battles with addiction. Also, fictional accounts were not appropriate for the
sample we wanted to analyze, so they were excluded.
After using these guidelines to focus our study we were left with twenty-five
relevant documentaries which we could use in our content analysis. The films were
produced, approximately, from 1997-2009 with an average length of about 60 minutes
each. To analyze the films we developed a content analysis template based on the
stipulations of our study. From our analysis we sought to investigate the demographics
of each film and how these addicts and their addiction narratives were being discussed
and/or treated. Our main objective was to review these medical narratives of addiction
and how they are used to explain a certain population, however it may not be used to
explain others such as minority groups. The following represents the content analysis
template used to evaluate each film:
14
Table 2. Content Analysis Template: Demographic Data
Documentaries:
Demographics
What is the problem being addressed?
Subjects: sex, age, race
How is the problem being defined?
Claimsmakers: sex, age, race
Who are making the claims?
What evidence are they using?
Who are the subjects?
Table 3. Content Analysis Template: Addiction Narrative
Defining the Problem:
Developing a Solution:
Narratives used by claimsmakers to
Narratives used by claimsmakers to
explain the subject’s problem
explain a solution
Narratives used by subjects to explain
Narratives used by subjects to explain a
the subject’s problem
solution
This content analysis template would be filled out accordingly, and in as
much detail as possible, during the viewing of each film. The problem being addressed is
the actual focus of each film, or what is being discussed. For example, some of the films
were connected by the theme of a certain drug (“Cottonland” – OxyContin or “Montana
Meth”); other films were focused on rehabilitation centers or programs, and the study of
addiction itself (“Rehab” and “Addiction”). How the problem is defined relates to how
the claimsmakers and subjects are explaining the situation at hand, whether it be a
15
specific drug or treatment program. “Who are making the claims” is a brief description
of the claimsmakers in each film; claimsmakers are defined as professionals in a field
(medical, law enforcement, legal, etc.) Therefore, family members were not included
among claimsmakers. The evidence they are using would refer to case studies, scientific
studies, and research which the claimsmakers are putting forth to corroborate the content
of the film. The subjects are the actual addicts presented in each film. The subjects that
were counted in our study were those who were named and thoroughly discussed in the
films; those who were not named and only contributed a passing comment within the film
were not counted in the sample.
The demographics of the claimsmakers and subjects were examined in each
film; the elements that were documented included age, sex and race. The drug addiction
narratives were examined by documenting the claimsmakers and the subjects’ views of
the problem and solution. Therefore, the claimsmakers view on the subjects is
documented by discussing why they began using drugs and how they could possibly
break free of their habits. The same discussion is documented among the subjects or
addicts themselves as well. From this examination of the demographics of the
claimsmakers and subjects, as well as the narrative put forth in each documentary one can
accurately establish a pattern of who is being presented in the sample and how their
situation is being explained.
The analysis of our findings will be based on comparing our demographic
data with that of the total population of drug addicts. Upon reviewing the 2008 National
Survey on Drug Use and Health (NSUDH), the total drug addicted population consists of
22 million people (ages 12 and older). Upon reviewing the percentages of addicts, based
on race, Whites comprise about 67% of the addicted population, African Americans
about 12.5% and Hispanics approximately 13.5% (Substance Abuse and Mental Health
16
Services Administration 2009). The percentages generated from our findings, regarding
the races of the subjects portrayed in each film, will then be compared to the
aforementioned statistics. This will determine whether or not these documentaries are
accurately depicting the population of drug addicts.
My methods were limited because of the difficulty associated with
determining the race of each subject. I had to rely on two tactics to determine race:
personal testimony and visually identification. Personal testimony refers to a subject
discussing their race and ethnicity; for example two Hispanic subjects explained that they
had been born in Latin American countries revealing their ethnicities. As this type of
discussion was rare, I had to rely on identifying their races by eyeballing; I would
observe and scrutinize their skin tone and determine their race. This method is obviously
flawed as skin color is not the best determinant of race and ethnicity. However, due to
the format of this media, visual idenfication was the most reliable method of determining
race.
17
Chapter 3
FINDINGS
Upon viewing all twenty-five films, the content analysis template was
completed. The data we extracted were the demographics (age, sex, race) of both the
subjects and claimsmakers, as well as the narrative patterns we concluded from each
case.
Demographics
Table 4. Subjects’ Racial Breakdown
Native
African
127 N
Hispanic
White
American
American
Female
57
1
0
0
Male
58
7
3
1
Totals
115
8
3
1
18
Table 5. Subjects’ Racial Breakdown by Percentage
African
White
Native
Hispanic
American
American
Female
44.9%
.8%
0
0
Male
45.6%
5.5%
2.4%
.8%
Totals
90.5%
6.3%
2.4%
.8%
Hispanic
Unknown
Table 6. Claimsmakers’ Racial Breakdown
African
114 N
White
American
Female
25
1
1
0
Male
72
7
1
7
Totals
97
8
2
7
19
Table 7. Claimsmakers’ Racial Breakdown by Percentage
African
White
Hispanic
Unknown
American
Female
21.9%
.9%
.9%
0
Male
63.2%
6.1%
.9%
6.1%
Totals
85.1%
7%
1.8%
6.1%
According to the data recorded, the largest majority of both subjects and
claimsmakers depicted or represented in these films were white. Out of 127 subjects, 115
were white or 90.5%, 8 subjects were African American or 6.3%, 3 were Hispanic or
2.4%, and 1 was Native American, .8% of the sample. Among 114 claimsmakers, 97
were white or 85.1%, 8 subjects were African American or 7%, and 2 were Hispanic or
1.8%. A fourth category was included among the claimsmakers for the narrators that
were not shown on camera. Narrators were included among claimsmakers because they
would often provide important background information regarding cases, research, etc. I
could infer the sex of the narrators that were not shown by their voices and their names
(normally displayed during the credits of the film), however their race was unknown if
they were not shown during the film.
In comparing the statistics generated from our sample to the total population
of drug addicts, it is evident that Whites are over-represented in these documentary films,
while minorities are almost invisible. Whites make up about 67% of the drug addiction
population, while 90.5% of the subjects in our sample were white. Similarly, of the
films’ subjects 6.3% were African American (as compared to 12.5% of the drug addict
20
population) and 2.4% were Hispanic (as compared to 13.5% of the population). Our
analysis was further broken down into the addiction narratives themselves, and how the
exclusion and misrepresentation of minorities was evident in a majority of the films.
Drug Addiction Narratives
After reviewing the content analysis we extracted the most common elements
of the narratives presented to examine the pattern of defining the problem and developing
a solution for drug addicts. These elements were again broken down according to the
narratives the subjects described and those from the claimsmakers.
Table 8. Drug Addiction Narratives
Defining the Problem
Subjects
Claimsmakers
Developing a Solution
o Experimentation
o Recreation/Fitting in
with friends
o Difficult family life
(Way to escape)
o Addiction (after
continued use)
o Medical treatments
o Rehabilitation
centers (even if
court ordered)
o Education
o Supportive family
and friends
o Psychological issues
(Result of traumatic
backgrounds)
o Social circles
o Mental and physical
addiction (chemicals
within the brain after
continued use)
o Medicinal
therapies
o Rehabilitation
centers/ Dual
diagnosis
o Change in lifestyle
o Advocated for
court ordered
treatment
o Psychiatric
treatment/ Therapy
21
The narratives presented by the subjects as to how their addiction
developed typically included how they started using drugs and when it became a problem
for them. Among subjects, the most common reasons they began using drugs include:
experimentation (as a result of curiosity), recreational use or social use because their
friends were using, or they used drugs to escape difficult family lives or situations. A
large majority of the subjects discussed that after continued use, no matter how they
began using, they became both physically and mentally dependent upon the drug they
used. Claimsmakers discussed many of the same scenarios for the onset of drug use: the
social circles or people that the subjects associate with and psychological issues which
can result from a traumatic experience or home life. Within our analysis we associated
psychological treatments, or therapy, with a medicalized narrative because it focused on
the manipulation of the brain and includes the diagnosis of mental disorders.
Claimsmakers, mainly medical and scientific professionals, also discussed
the eventual dependence a user will have on a drug after continued use. However, these
medical doctors and scientific researchers discussed the issue further and explained the
change in the chemicals of an addict’s brain which causes them to become dependent.
In terms of developing a solution, subjects described the use of certain
programs, medical treatments, and a change in their lives that they could undergo to
achieve and maintain sobriety. These treatments and changes include: medical
procedures, rehabilitation centers, a continued education, and the support of family and
friends. Medical procedures include Naltrexone implants, rapid detox, and methadone
treatments. The trend among claimsmakers is similar in regards to a solution for
addiction: medicinal therapies (rapid detox, methadone, etc.), rehabilitation centers (focus
on a dual diagnosis to treat psychological problems as well), therefore they advocated for
22
psychiatric treatment, and a change in lifestyle (including a change in social environment
or friends).
Exclusion of Minorities
Our content analysis and data has highlighted a continuous pattern of
exclusion for minority groups in terms of drug addiction research. In our literature
review we understand that not only are minorities largely excluded from medicalized
drug addiction research, but their drug addiction is most often viewed using a
criminalized narrative instead. In our content analysis of the films, we found that 90.5%
of the subjects portrayed in our sample were white, while 6.3% were African American
and 2.4% were Hispanic. This overwhelming disparity among races perpetuates this
exclusion of minorities from medicalized drug addiction research. Of the cases that were
shown, the most common portrayed in the films included young, white teens from the
middle of America who had promising futures and lost it all to the disease of drug
addiction or young white teens who had rough lives and got involved with the wrong
crowd. Also, many of the minorities that were subjects would often have less screen time
than their white counterparts and we seen as peripheral “characters,” used to comment on
other subjects.
“Rehab” - Ally and Marvin
Ally, 22 - white, female, heroin addict: had a pretty good childhood, no
abuse; always felt different from everyone; disconnected herself from her
family (only one who has had substance abuse problem); tried heroin in art
school in San Francisco (wanted to live a "screwed up, poetic life... sought
out the high") Used everyday - $200 a day habit; would be suffering for a
fix (chills, etc.) Was locked out of her home and ended up at Camp
Recovery; "Addicts aren't easy people to love."
Marvin - black, male, recovering addict at Campy Recovery; comments
on Ally - "she just needs to let that shit go… you’re beautiful."
23
In this instance Marvin was used as a commentator and very little
background information was given on the only minority that appeared as a subject in this
film. In fact, minorities were often portrayed within the films as dealers or unnamed
friends of the subjects on the streets.
“American Justice: The Junkie Next Door” - Allison
Allison, 23 - white, female: Says it's hard for her to meet people (it's easier
when she's high); She was looking for something and found it in drugs;
She goes to the “Badlands ("Philadelphia's deadly drug dealing
neighborhood") to buy heroin and crack; They smoke crack then use
heroin "to come back down." "Now, I'm not as shaky from the rock... now,
I can start smoking rock again..." She hasn't used heroin since filming and
is more committed to her methadone treatment.
The documentarians filmed Allison’s trip to the Badlands, and although the
face of her dealer was blurred out, one could surmise the dealer was an African American
male (as one could see his hands, body type, and clothes).
Medicalization of Drug Addiction
As shown within our analysis template, the overriding pattern within the
documentary films examined was to look at drug addiction from a medicalized
standpoint. Therefore, the subjects were viewed as patients that were to be treated in
rehabilitation centers and clinics, rather than criminals. While many had been convicted
of crimes, usually performed to support their habits, most were required by the courts to
enter into a rehabilitation program (in terms of probation or to avoid jail time).
“Meth: A County in Crisis - Cody”
Cody, 22 - white, male: "Quitting drugs and alcohol was easy, changing
every aspect of my life is the most difficult thing I've ever had to do." He
started using meth after his 21st birthday (an old girlfriend got him into it)
- he started using everyday; He was arrested for violating house arrest on
an old burglary charge – he was able to choose drug court and treatment
over jail time; Was almost thrown out of the treatment program for not
24
doing community service work; he had to write a paper and submit it to a
judge to determine if he stays or goes, which the judge accepted
“Dope Sick Love” - Michelle
Michelle - white female; smokes crack; Michelle was arrested for
possession of crack and was sentenced to a treatment program; offered a
detox…
In both cases, the subjects were given drug treatment as an option over
criminal jail time. Therefore, the legal system saw it as more beneficial for society and
the individual that they enter into a treatment program. This type of treatment involved
psychological analysis, discussion groups/therapy, and one could possibly be prescribed
medication for a disorder. Other cases involve actual medical procedures and medication
for the addiction itself.
“Constant Craving: The Science of Addiction” - Melanie
Melanie - white, female: has been a heroin addict for four years; She was
placed on morphine (sustained release tablets); they stop her from going
into withdraw; She will be entering Colin Brewer's clinic that works with
alcoholics and heroin addicts which specializes in Naltrexone implants;
She gets the implant on the fifth day of withdraw - it will block the
receptors that usually take the heroin; Once it completely dissolves the rest
is up to her; She has actually been able to refuse heroin offers; "I've been
given a chance to prove myself... getting back to real life is nice..."
Colin Brewer - white, male: The Stapleford Unit - "Naltrexone blocks the
affects of heroin..." if you take it nothing will happen; Some have one,
some have a series of implants… with the implant it's almost impossible to
relapse.
According to Dr. Lance Gooberman (“American Justice: The Junkie Next
Door”) Naltrexone is implanted into a patient and dissolves over the course of about two
months. The Naltrexone attaches itself to where the opiates (heroin) would attach and if
a patient attempts to use the drug they will not be able to feel the affects. The goal is for
the addict to live without the cravings and create an environment where heroin is
25
ineffective so that they may be able to maintain a sober lifestyle once the pellet fully
dissolves.
“Birthday: Methadone and Pregnancy - Denise”
Denise, 21 - white, female: recovering heroine addict… used heroine daily
for 4 years; 5 months into her pregnancy she started using methadone
replacement therapy; she goes to a drug rehabilitation clinic everyday and
receives 30 mg of methadone
These types of treatments coincide with the information provided by claimsmakers that
the chemicals within the brain are affected and manipulated by drugs which leads to the
addiction of the user.
“Risky Business: Teens and Addictive Behavior – The Science of Addiction”
Tracy Smith - white, female: host - "Through science we've learned that
addiction is not just a behavioral or a psychological problem, it's a medical
problem as well." When we feel pleasure the brain releases dopamine,
drugs and alcohol release this as well; when drugs and alcohol enter the
brain is causes and excess of dopamine; the body gets used to this level of
dopamine and therefore craves more drugs - "A high concentration of
dopamine causes changes in the brain's chemistry."
“Constant Craving: The Science of Addiction”
Anna Rose Childress - white, female: deals with craving - the
compulsion of addicts to seek out drugs even if they don't get much
pleasure from them; She wants to pinpoint where the craving starts in the
brain; She is studying the power of thought - an area of the brain is
stimulated in anticipation of the high - her research is trying to help
addicts overcome this anticipation
According to these claimsmakers and the treatments that many of the subjects
have undergone, these films have contributed to the research that addiction is a brain
disease and can be treated as such. Drug treatment therapies involve rehabilitation
centers, which include psychological analyses and treatment, and breakthrough
medications and medical procedures. The fact that the large majority of the subjects
26
portrayed within theses films were white supports our hypothesis that these films are
perpetuating the exclusion of minorities from a medicalized view of drug addiction.
27
Chapter 4
CONCLUSIONS/DISCUSSION
Conclusion
Our research has examined the fact that drug addiction is being increasingly
medicalized, but not for all drug addicts. The medicalization of drug addiction, and the
classification of addiction as a brain disease can have extremely beneficial results for
addicts and allow them to be properly treated and rehabilitated. This medical narrative
pattern, which has been rapidly developing over the past decade and a half, is a refreshing
change from the dominating criminalized narrative which governed drug policies and the
stigma of addiction throughout the 20th century. In reviewing current drug addiction
research and reviews, it is evident that there are racial disparities within these studies.
According to surveys of drug use and abuse, minorities are overwhelmingly
misrepresented in accordance with their population statistics; however, they are underrepresented or mistakenly represented in addiction research. With a focus on the white
majority, and a one-dimensional view of ethnographic research of minorities, there is as
inaccurate portrayal of the drug addict population.
With the continual need to endorse the medicalized narrative of addiction, to
influence the public’s support of their treatment, certain media sources like television
shows and documentary films have become extremely important. Documentary films are
able to humanize the narrative of the drug addict and put a face on the social problem of
addiction. In depicting the addict as a patient, who suffers from a disease, the audience is
able to sympathize with their situation. Also, with their strong link to mainstream media
28
and influence in the public sphere, they are the strongest tool for claimsmakers to reach a
wider audience. Therefore, in our examination of these films, we focused on how the
addict and their addiction narratives were being scrutinized and explained as these claims
would be a tool to influence public opinion. Overwhelmingly, a majority of these films
discussed the medicalization of drug addiction and the diagnosis of addiction as a brain
disease. However, out of 127 subjects (in 25 films) 90.5% were white addicts, mainly
from rural areas in Middle America. Given that in the drug addict population, 67% of
addicts are White, these films provided a disparate view of the entire drug addiction
population. In our analysis, Whites were dramatically overrepresented in these films
while minorities are almost invisible or severely misrepresented. In conclusion, because
these films are among the strongest links to mainstream society, how they explain
addiction and who is being discussed is an issue of great consequence and influence. As
stated before, if you are not seen as a patient then you are not receiving treatment.
Discussion
Future research regarding the medicalization of drug addiction can examine
other sources such as those with a stronger relation to commercial media, like the
television series “Intervention”. A more conclusive look at addiction as a disease could
also include how this portrayal of addicts influences the acquisition of resources; in other
words are minorities not able to receive treatment or do they have a more difficult time
entering treatment programs based on the most common views of minority drug addicts.
The disparity of race and gender among claimsmakers may also be examined further and
how this disparity also influences the narrative depicted to the general public.
This research also raises questions regarding the process of producing
documentary films based on the intentions of researchers and claimsmakers. One can
infer that a social problem is not seen as a pressing issue unless it impacts the white
29
middle class. Therefore, this is the audience that is most likely to be targeted with the
promotion of new research; if the white middle class finds a connection to a social
problem or feels threatened by it, they are the population that can encourage and
influence change. The motives of the filmmakers, and their supporters, could thereby be
influenced by this idea and impact the subjects being portrayed. In promoting drug
addicts as patients within these films, producers may find it more beneficial to depict
white, middle class addicts so as to reach out to the population that can stimulate change.
These processes could be examined more closely by examining the production companies
and monetary supporters of each film.
This research indicates a problem within drug addiction research, as well as
how medicalization as a whole can be influenced and shaped according to racial
disparities. The stigmatizing view of the addict, as a result of the War on Drugs and
stigmatization of drug abusers throughout the 20th century, can be combated through this
medicalized view. With a focus on this narrative, the treatment of addicts can be
properly examined and modified to move towards a successful strategy of rehabilitation.
However, if the general public, along with policy makers, are not given an accurate view
of the addict, the entire drug addicted population will not receive equal recognition and
help. Therefore, the representation of addiction as a brain disease, coupled with a biased
view of which addicts are patients, stalls the appropriate progression of substance abuse
treatment and causes inequality among those who will receive the proper treatment.
30
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